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2011•Journal of Antimicrobial ChemotherapyOpen access

Comparative effectiveness of continuing a virologically effective first-line boosted protease inhibitor combination or of switching to a three-drug regimen containing either efavirenz, nevirapine or abacavir

Tchadie Bommenel, Odile Launay, Jean Luc Meynard, Jacques Gilquin, Christine Katlama, Anne‐Sophie Lascaux, Aba Mahamat, Valérie Martinez, Christian Pradier, É. Rouveix, Anne Simon, Dominique Costagliola, Sophie Abgrall, S. Abgrall, on behalf of FHDH-ANRS CO4, S. Abgrall, S. Abgrall, F. Barin, M. Bentata, Éric Billaud, François Boué, C. Burty, André Cabie, D. Costagliola, L. Cotte, P. de Truchis, Xavier Duval, C. Duvivier, P. Enel, Jacques Gasnault, C. Gaud, J. Gilquin, Sophie Grabar, C. Katlama, M.-A. Khuong, Jean-Marie Lang, A. S. Lascaux, O. Launay, Aba Mahamat, Murielle Mary‐Krause, Sophie Matheron, J. L. Meynard, J. Pavie, G. Pialoux, F. Pilorge, I. Poizot-Martin, C. Pradier, J. Reynes, É. Rouveix, A. Simon, P. Tattevin, Hervé Tissot‐Dupont, J. P. Viard, N. Viget, Marc Brosseau, V. Salomon, Nicolas Jacquemet, M. Guiguet, Émilie Lanoy, Laurence Lièvre, Hana Selinger‐Leneman, Jean‐Michel Lacombe, Valérie Potard, F. Bricaire, S. Herson, N. Desplanque, Pierre‐Marie Girard, M. C. Meyohas, O. Picard, Jacques Cadranel, C Mayaud, JP Clauvel, J.M. Decazes, Laurence Gérard, Jean‐Michel Molina, Myriam Diemer, Pierre‐Olivier Sellier, P. Honoré, V. Jeantils, S. Tassi, D. Méchali, Bernard Taverne, E Bouvet, B. Crickx, J. L. Ecobichon, C. Picard‐Dahan, P. Yéni, Huguette Berthé, C. Dupont, C. Chandemerle, Éric Mortier, D. Tisne-Dessus, L. Weiss, D. Salmon, I Aupérin, Laurent Roudière, Rita Fior, J. F. Delfraissy, Cécile Goujard, Corinne Jung, P. Lesprit, D. Vittecoq, Philippe Fraisse, D. Rey, Geneviève Beck-Wirth, J.‐P. Stahl, P. Lecercq, F. Gourdon, H. Laurichesse, A. Frésard, F. Lucht, C. Bazin, Renaud Verdon, P. Chavanet, C. Arvieux, C. Michelet, P. Choutet, A. Goudeau, M. F. Maitre, Bruno Hoën, P. Elinger, J Faller, F. Borsa-Lebas, F. Caron, J.P. Daurès, T. May, Christian Rabaud, J L Berger, Gérard Rémy, E. Arlet‐Suau, Lise Cuzin, Patrice Massip, M. F. Thiercelin Legrand, G Pontonnier, Y. Yasdanpanah, P. Dellamonica, Pellegrina Pugliese, Krzysztof Aleksandrowicz, D. Quinsat, Isabelle Ravaux, J Delmont, J.F. Moreau, J. A. Gastaut, F. Rétornaz, J. Soubeyrand, Anne Galinier, J.M. Ruiz, T. Allegre, Pierre Blanc, D. Bonnet-Montchardon, G. Lepeu, P. Granet-Brunello, J. P. Esterni, Léna Pélissier, R. Cohen-Valensi, Meyer Nezri, S. Chapadaud, A. Laffeuillade, F. Raffi, A. Boibieux, D. Peyramond, J.‐M. Livrozet, J. L. Touraine, C. Trépo, M. Strobel, F. Bissuel, R Pradinaud, M. Sobesky, M. Contant

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Abstract

OBJECTIVES: To compare virological effectiveness in patients who continued on a virologically successful first-line boosted protease inhibitor (PI)-containing combination antiretroviral therapy (cART) regimen or who switched to a PI-free cART including efavirenz, nevirapine or abacavir. METHODS: From the French Hospital Database on HIV, we selected 439 patients with undetectable viral load (VL) on a first-line boosted PI-containing cART regimen who switched to a PI-free combination including efavirenz, nevirapine or abacavir. Each of these patients was matched with three patients who continued to take their first-line cART regimen, on the basis of gender, age, CD4 cell count, VL, date of cART initiation and the duration of VL undetectability. Time to virological failure (VF) was analysed with Kaplan-Meier curves and Cox models. RESULTS: The 12 month probabilities of VF were 3.7% and 5.7% in non-switch and switch patients, respectively, and 3.9%, 7.2% and 9.0% in patients switching to efavirenz-, nevirapine- and abacavir-containing cART, respectively. After adjustment, only patients switching to abacavir-containing cART had a higher risk of VF than non-switch patients (adjusted hazard ratio, 1.99; 95% confidence interval, 1.05-3.79). CONCLUSIONS: Switching from a virologically successful first-line boosted PI-containing cART regimen to a non-nucleoside reverse transcriptase inhibitor-containing cART regimen containing either efavirenz or nevirapine is virologically safe, while switching to abacavir-containing cART should be avoided.

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OBJECTIVES: To compare virological effectiveness in patients who continued on a virologically successful first-line boosted protease inhibitor (PI)-containing combination antiretroviral therapy (cART) regimen or who switched to a PI-free cART including efavirenz, nevirapine or abacavir. METHODS: From the French Hospital Database on HIV, we selected 439 patients with undetectable viral load (VL) on a first-line boosted PI-containing cART regimen who switched to a PI-free combination including efavirenz, nevirapine or abacavir. Each of these patients was matched with three patients who continued to take their first-line cART regimen, on the basis of gender, age, CD4 cell count, VL, date of cART initiation and the duration of VL undetectability. Time to virological failure (VF) was analysed with Kaplan-Meier curves and Cox models. RESULTS: The 12 month probabilities of VF were 3.7% and 5.7% in non-switch and switch patients, respectively, and 3.9%, 7.2% and 9.0% in patients switching to efavirenz-, nevirapine- and abacavir-containing cART, respectively. After adjustment, only patients switching to abacavir-containing cART had a higher risk of VF than non-switch patients (adjusted hazard ratio, 1.99; 95% confidence interval, 1.05-3.79). CONCLUSIONS: Switching from a virologically successful first-line boosted PI-containing cART regimen to a non-nucleoside reverse transcriptase inhibitor-containing cART regimen containing either efavirenz or nevirapine is virologically safe, while switching to abacavir-containing cART should be avoided.

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Available abstract

OBJECTIVES: To compare virological effectiveness in patients who continued on a virologically successful first-line boosted protease inhibitor (PI)-containing combination antiretroviral therapy (cART) regimen or who switched to a PI-free cART including efavirenz, nevirapine or abacavir. METHODS: From the French Hospital Database on HIV, we selected 439 patients with undetectable viral load (VL) on a first-line boosted PI-containing cART regimen who switched to a PI-free combination including efavirenz, nevirapine or abacavir. Each of these patients was matched with three patients who continued to take their first-line cART regimen, on the basis of gender, age, CD4 cell count, VL, date of cART initiation and the duration of VL undetectability. Time to virological failure (VF) was analysed with Kaplan-Meier curves and Cox models. RESULTS: The 12 month probabilities of VF were 3.7% and 5.7% in non-switch and switch patients, respectively, and 3.9%, 7.2% and 9.0% in patients switching to efavirenz-, nevirapine- and abacavir-containing cART, respectively. After adjustment, only patients switching to abacavir-containing cART had a higher risk of VF than non-switch patients (adjusted hazard ratio, 1.99; 95% confidence interval, 1.05-3.79). CONCLUSIONS: Switching from a virologically successful first-line boosted PI-containing cART regimen to a non-nucleoside reverse transcriptase inhibitor-containing cART regimen containing either efavirenz or nevirapine is virologically safe, while switching to abacavir-containing cART should be avoided.

Key concepts: Efavirenz, Nevirapine, Abacavir, Regimen, Reverse-transcriptase inhibitor, Cart, Lamivudine, Medicine

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Comparative effectiveness of continuing a virologically effective first-line boosted protease inhibitor combination or of switching to a three-drug regimen containing either efavirenz, nevirapine or abacavir — Research Paper | ScholarLens